Quantity or quality: What aspects of clinical rotations influence career choice?

A tempting response to workforce shortages in key medical specialities is to increase exposure to those specialities in medical school-on the basis that a longer time will result in greater enthusiasm. However, evidence for this response is limited. This study aimed to evaluate the association between length of speciality exposure during medical school and career intentions at graduation, while accounting for students' intentions on entry to medical school.

Data were drawn from the Medical Schools Outcomes Database for cohorts entering New Zealand medical schools between 2007 and 2015 and graduating in 2011 and 2019. Career preferences were recorded at entry and exit, alongside medical school duration data, which detailed weeks of exposure to major specialities across four separate campuses. A five-point scale captured the degree of career interest, enabling changes from entry to exit to be calculated. Gradient coefficients correlated exposure length with a change in interest. Additional analyses examined self-reported factors influencing speciality preferences at graduation and up to postgraduate year 8. Alongside this, students were surveyed on factors influencing career preferences.

Overall, a weakly positive relationship was observed between exposure duration and increased interest. There were no significant speciality-specific associations. Importantly, the influence of undergraduate speciality experience on career preference declined sharply after graduation. In contrast, speciality culture and atmosphere remained consistently strong influences across all stages.

These findings suggest that merely extending undergraduate exposure is unlikely to enhance career interest. Instead, the quality of the experience, particularly the culture of the speciality and role-modelling by clinicians, plays a more enduring role in shaping career intentions. Strategies to strengthen speciality cultures and align them with students' values may be more effective than increasing time alone.